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SLEEVE GASTRECTOMY
DIET STAGES 1-5
Name:
____________________________________
Date:
____________________________________
Dietitian:
____________________________________
Phone:
____________________________________
Revision 06/16/2013 2
SIX STEPS TO SUCCESS
The first year after surgery is a critical time that must be dedicated to changing old behavior and forming
new, lifelong habits that will control your weight. In a survey* completed by 100 people who have had
weight loss surgery during the past 20 years, certain changes were more likely to be associated with
long-term success. These changes include:
EATING--Eat three well-balanced meals and two snacks per day.
DRINKING--Drink water rather than juice, carbonated, sweetened, caffeinated and alcoholic
beverages.
VITAMIN SUPPLEMENTATION -Take daily multivitamin (see list of recommended
products on last page), calcium+vitamin D, vitamin B12 and if directed, additional
vitamin D, iron, zinc and biotin.
SLEEPING--Sleep an average of at least 7 hours each night.
EXERCISE--Exercise at least four times a week for 40 minutes or more.
PERSONAL RESPONSIBILITY--Take personal responsibility for staying in control. Monitor
weight weekly. Monitor intake to control weight.
* SUCCESS HABITS OF LONG-TERM GASTRIC BYPASS
PATIENTS; Colleen Cook; Charles Edwards MD; Obesity Surgery,
9,1999
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PRESURGICAL DIET
Your diet is important in the months and weeks prior to surgery. Gaining weight can make the technical
aspects of your surgery more difficult. Losing weight prior to surgery can significantly reduce operative
complication rates.
In the final two weeks prior to surgery strict liquid protein diet is mandatory to reduce conditions
such as a fatty liver, which can get in the way during surgery and can significantly increase the risk of the
procedure.
Our top recommendations include the Bariatric Fusion® Meal Replacement, the Bariatric
Advantage® High Protein Meal Replacements and powders and the Unjury® Protein
Containers.
They are available through the internet:
www.bariatricfusion.com
www.bariatricadvantage.com
www.unjury.com
The Bariatric Fusion® Meal Replacement products and vitamins are available in the Gift Shop at
Lawrence Memorial Hospital, Medford.
The protein shakes should be prepared with ice-cold water or skim milk (4-6 oz to 1 scoop of
protein powder), using a blender! Blend the mixture for 45-60 seconds.
Please maintain a sensible diet as you await your surgery.
Significant weight gain may result in cancellation of your surgery and re-evaluation of your candidacy for
surgery.
The day before surgery consume only protein shakes and after 5 pm clear liquids (water, broth,
tea, ginger ale, jello). It is of outmost importance that the stomach is completely empty at the
time of surgery.
NON-ADHERENCE TO THE ABOVE MAY RESULT IN CANCELLATION OF YOUR SURGERY!
Consume nothing by mouth after midnight.
Nutrition goals to help you prepare for surgery:
1.
2.
3.
4.
Eat three meals at regular times each day.
Reduce non-hunger snacking.
Eliminate sweetened beverages.
Lose at least 10-15 lb prior to surgery. Patients with a BMI over 55, should lose 10% of their body
weight.
Other Goals:
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Post Surgical Diet
Sleeve gastrectomy is a surgical procedure in which the size of the stomach is reduced by 90%. This
can help promote weight loss by causing a feeling of fullness after very small meals and dramatically
reducing hunger between meals. However, surgery itself will not lead to weight loss.
The way you eat after surgery must be permanently altered. Initially, both the consistency and the
volume of food will be restricted to allow for healing, while providing essential nutrients. Your long-term
goal is to continue to restrict the volume of food while providing a more nutritionally balanced intake.
These guidelines will provide you with information to help you modify your intake and maximize the
benefits of surgery.
Problems may arise after surgery. Some of these will go away with time, while others can be controlled
with adjustments of the diet. Below are some guidelines to help you to prevent or minimize these
problems.
1. Always eat or drink very slowly. Meals should be paced to last about 30 minutes even when
the amount is very small. Eating too quickly may cause nausea and vomiting.
2. Chew food thoroughly. All food should be chewed to a liquid consistency while in the mouth.
Food that is not thoroughly chewed can cause nausea and vomiting or may cause blockages in
outlets.
3. Eat foods or beverages only in the amounts suggested. Eating larger amounts may cause
vomiting, weight gain, expansion and even rupture of the stomach.
4. Do not drink with meals, instead only 30 to 60 minutes before or after meals. This may
overload the stomach causing nausea and vomiting, and also may cause expansion and rupture
of the stomach.
5. Drink plenty of fluids - slowly. Without adequate fluids, the body will become dehydrated,
especially if vomiting or diarrhea occurs. To prevent dehydration, drink 3 to 4 ounces of water or
other acceptable low-calorie beverages between meals.
6. Avoid foods that contain a lot of sugar. Reduce your intake of sweets. High sugar foods are
also often high in calories but contain few nutrients, and thus, may affect the nutritional
adequacy of your diet and your ability to lose weight.
7. Always take the vitamin and minerals supplements prescribed.
8. Purchase recommended vitamins, minerals and liquid supplements prior to surgery.
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9. Maintain the diet that is recommended for your recovery stage.
STAGE 1: WATER
Start:
Usually within a day after surgery
Foods allowed:
One fluid ounce (30 cc) water per hour
Reminders:
Please use the 1 ounce medicine cups provided to sip your
water. This will help to keep you from drinking too fast.
Write down the amount of water that you drink on the fluid
record sheet that will be provided.
STAGE 2: SUGAR FREE CLEAR LIQUIDS
Start:
Usually by noon on the day after surgery
Foods Allowed:
One to three fluid ounces (30-90 cc) of regular broth, water,
sugar-free gelatin, or decarbonized (“flat”) diet ginger ale per hour.
Goal:
1 quart or 32 ounces per day
Reminders:
Stop sipping as soon as you feel full.
Never force yourself to finish.
If you choose to drink ginger ale, make sure that it is
sugar-free and “flat”. Carbonated beverages may cause stomach
discomfort. Decarbonize the soda by letting it sit open for at least
one hour prior to drinking.
Once you reach your fluid goal, your intravenous fluid may
be discontinued.
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STAGE 3: LOW SUGAR, PROTEIN ENRICHED LIQUIDS
Start:
Usually two days after surgery.
Duration:
2-3 weeks or until follow-up appointment with dietitian
Foods Allowed:
Four fluid ounces of a sugar-free, nutritional supplement every 2 hours, 8
times a day. A list of suggested supplements and purchasing information is provided on the
next page. Four to eight fluid ounces of clear liquids should be taken between the supplements.
Acceptable clear liquids include:
water
sugar-free beverages such as Crystal Light or sugar-free Kool-Aid
coffee or tea (preferably decaffeinated)
bouillon or broth
"flat" diet soda (preferably decaffeinated)
tomato or V-8 juice
sugar-free popsicles (less than 20 calories each, limit to 2 per day)
fruit juice without added sugar
(do not exceed 4 ounces per serving or a total of 8 ounces per day)
Gatorade (do not exceed 8 ounces per day)
sugar-free gelatin
(A sample meal plan is provided below)
Fluid Goal:
At least 48 ounces (6 cups) daily, including both the sugar-free,
nutrient-enriched beverage plus allowed clear liquids. Sip all liquid slowly. Stop drinking
immediately if you feel full or experience discomfort.
Protein Goal:
At least 70 grams of protein per day. Calculate the volume of protein
shake you need using the per serving protein volume printed on the label of the product you
chose.
Supplements:
Take two adult chewable multivitamin (see list on last page) plus three
600 mg chewable calcium carbonate + vitamin D per day.
Take each with a meal to aid absorption.
Reminders:
Sip all liquids slowly over a 30 minute time span.
Continue to record your food and fluid intake
If you cannot tolerate regular milk, try Lactaid 100 milk or Lactaid drops. In case of
diarrhea you may also try Imodium suspension (over the counter).
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SUGGESTED PRODUCTS TO MEET YOUR NUTRITIONAL NEEDS
Try to purchase at least one of these products before your scheduled surgery.
Protein powders (nutritional supplements)
Product Name
Protein (grams)
Manufacturer
per scoop
Bariatric Fusion® Meal Replacement
27
Bariatric Fusion
Bariatric Advantage High Protein Meal
27
Bariatric Advantage®
20
Unjury
Replacement
UNJURY Protein
The nutrient-enriched supplements and the protein powders are available in the Gift Shop at Lawrence
Memorial Hospital in Medford or they can be purchased via the manufacturer’s website:
Check with your dietitian if you wish to use other supplements or protein powders.
We do not recommend Carnation Instant Breakfast® or Boost® products for weight loss surgical
patients! Although, they taste good and are easy to consume, they were designed for an entirely
different purpose and carry a lot more calories than you want to take at this phase.
Chewable and liquid multivitamins
1. Multivitamin
Primary recommendation: Bariatric Fusion® Complete Chewable Vitamin and Mineral
Supplement (recommended dose 1 tablet twice a day)
Additional Calcium and Vitamin D supplement is not necessary with this product
Alternatives (see list on last page): Centrum Ultra Women’s Tablets, CVS Spectravite Performance
Tablets, Walgreens One Daily Healthy Weight, Walgreens A to Z Active Performance or Flintstones
Complete Chewable Tablets Complete.
Take 1 of these tablets twice daily.
2. Chewable calcium:
Caltrate 600 + D chewable 1 tablet twice daily.
Calcium Citrate + D chewable 1 tablet twice daily
Viactiv Calcium +D chewable 1 tablet twice daily
Later, in stage 5, non-chewable formula can be used. Active ingredients should be 600 mg calcium and
least 400 IU of vitamin D per tablet.
3. Vitamin B12 sublingual (you place under your tongue) - 1 tablet daily
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STAGE 3: SAMPLE MEAL PLAN
Foods allowed at this time include meals of sugar-free nutritional supplements.
Sugar-free clear liquids should be taken between meals. Remember to sip all liquids
slowly.
8:00 a.m.
9.00 a.m.
10:00 a.m.
11:00 a.m.
12:00 p.m.
1:00 p.m.
2:00 p.m.
3:00 p.m.
4:00 p.m.
5:00 p.m.
6:00 p.m.
7:00 p.m.
8:00 p.m.
9:00 p.m.
10:00 p.m.
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
4-8 ounces sugar-free clear liquids
4 ounces sugar-free nutritional supplement
* Do not use nutritional supplements that are not on the list unless you have
checked with your nutritionist to see if other products are adequate to meet your
nutritional needs during stage 3.
STAGE 4: PUREED TO SOFT DIET (START 2-3 WEEKS AFTER THE OPERATION)
1) Pureed to soft foods from the list below can now GRADUALLY be added to your
diet.
2) Six meals per day supplementing with liquid protein supplements to reach your
Protein Goal 70 grams daily.
3) No liquids with meals if soft food is included. **You must wait 30 minutes for the
stomach to empty before drinking.
4) CHEW WELL!! The food must be almost liquefied before swallowing.
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PUREED TO SOFT DIET (do not combine food selections!)
> One item from below for designated meal only
On WEEK 3 gradually try:
·
Blenderized soup
·
Oatmeal, grits, cream of wheat
Scrambled eggs
·
Cottage cheese
·
Yogurt with fruit pieces
·
Soft fruit (banana, melon, strawberries)
·
Soft Vegetables cooked well (skinless)
·
Soft cooked eggs, chopped/ground well
·
Toast or crackers with peanut butter
·
Light white fish, such as haddock or scrod
Please remember, if you have pain or vomit after trying something new, return to
liquid diet for 24 hours before resuming stage 4 diet. Don’t get discouraged if you
vomit after trying something new. Take a note of it and you may try it again in 2-3
weeks. I
STAGE 5 REGULAR DIET: (START AFTER 4-5 WEEKS FOLLOWING SURGERY)
Gradually add regular foods and remember:
1.
2.
3.
4.
Eat your protein portion of your meal first (they satisfy hunger longer).
Occasionally your 3 meals may turn into 5 small meals.
NO LIQUIDS with meals (only 30-60 minutes before and after)
Avoid cheap calories.
Fats
High calorie liquids
Sweets, ice cream, junk food, cookies.
5.
Decrease protein supplements as you consume more proteins in your diet. If
you feel that by the end of the day you will not be able to take 70 gram of protein, you
may supplement your diet with the necessary amount of protein shake.
*This is a gradual process as you learn how to incorporate protein sources in your diet
other than supplements. Advancing to stage 5 diet may take 2-6 weeks.
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SUMMARY

Follow 5-stage diet plan to allow for a gradual adjustment

Eat only at set meal times.
(If you feel hungry between meals try water. Thirst is often confused with hunger.
If you must snack try some protein, a rice cake or other no calorie foods). NO
GRAZING.

Go slow, chew well.

When your feel full: STOPI!

If it is late during the day and you are far from completing your daily goal of
protein intake (70 g), replace with some protein shake.

Junk foods and sweets do not relieve hunger. Only solid foods, which fill the
stomach and empty slowly, will relieve hunger.

Pre-portion your meal, use small plate. It is OK to leave food on the plate and it
may take a half an hour to finish your meal. Only eat more if you finished the
portion and you are truly hungry. Do not experiment to see how much you can
really eat!
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Recommended Vitamin Supplements for Sleeve Gastrectomy Patients:
Bariatric Fusion® is a complete chewable vitamin and mineral supplement and comes in various flavors. Take 1 tablet twice a day + Vitamin B12 sublingual – 1 tablet daily Available at the Lawrence Memorial Hospital Gift Shop or from www.bariatricfusion.com ALTERNATIVE: 1. Select any of the multivitamins below and take one tablet twice a day Celebrate Multi Complete Centrum Ultra Women’s Tablets Walgreens Premium Flintstones Chewable CVS Tablets Complete Formula A Thru Z Spectravite Performance Active Performance Usp Tablets 2. Take Calcium + D supplements twice a day from any of the products below: Caltrate 600+D Calcium Citrate+D 3. Take 1 sublingual Vitamin B12 tablet daily Viactive Calcium+D